Form AF-01

A P P L I C A T I O N F O R M (for all categories)

In terms of Sections 11(1), 12(1) and 13(1) of the Engineering Profession Act (Act 18 of 1986)
Instructions: Please download and read the registration information sheet before completing this form
1. APPLICANT:
SURNAME: Mafara TITLE: (eg. Prof, Dr, Mr) Mr.

FIRST NAME(S): Richard Junior DATE OF BIRTH: 01-10-1996

2. QUALIFICATIONS: (All qualifications at tertiary level)

EDUCATIONAL INSTITUTION(S) QUALIFICATION(S) ATTENDANCE DATE OF FINAL
From To EXAMINATION

University of Namibia Bsc. Civil Engineering 2016-2020 May 2020

3. ADDITIONAL PERSONAL DETAILS:

NATIONALITY: NAMIBIAN IDENTITY NO: NON-CITIZENS
PASSPORT NO:_______________ISSUING
FN080782 Zimbabwe
COUNTRY:______________
Zimbabwean 00137
VISA NO:____________________VISA TYPE:_____________________
Domicile
VISA VALIDITY: from_________________to______________________
26/03/23 25/03/24
HOME ADDRESS: 36 Omongo Street, Windhoek POSTAL ADDRESS: P.O Box 40451
Windhoek
TELEPHONE (HOME): n/a

CELL PHONE: 081 825 2029

E-MAIL: r.mafarajnr@gmail.com

COLOR PHOTOGRAPH

Passport type

CURRENT EMPLOYER’S NAME: Pregon Consulting Engineers

EMPLOYER ADDRESS: 06 Popa Street, Klein Kuppe, Windhoek

YOUR POSITION: Civil Engineer

TELEPHONE (WORK): +264 (83) 288 8289

4. APPLICATION DETAILS: Application Form - Page 2 of 4
CATEGORY & DISCIPLINE BEING APPLIED FOR (Please tick appropriate box and indicate discipline)
PROFESSIONAL ENGINEER INCORPORATED ENGINEER ENGINEERING TECHNICIAN

DISCIPLINE:_____________________ DISCIPLINE:_________________________ DISCIPLINE:_________________________

______________________________ SUB-DISCIPLINE:_____________________ SUB-DISCIPLINE:_____________________

X ENGINEER-IN-TRAINING INCORPORATED ENGINEER ENGINEERING TECHNICIAN

-IN-TRAINING -IN-TRAINING
DISCIPLINE:_____________________
Civil Engineering DISCIPLINE:_________________________ DISCIPLINE:_________________________
______________________________ SUB-DISCIPLINE:_____________________ SUB-DISCIPLINE:_____________________

5. CURRENT REGISTRATION WITH THE ECN AND/OR REGISTRATION WITH OTHER PROFESSIONAL BODIES
PROFESSIONAL BODY CATEGORY DISCIPLINE & SUB-DISCIPLINE REG. NO.

6. REFEREES:
• Applications for registration as “in training” do not need Referee Reports
• At least two Referees are required and they must be registered with the Engineering Council of Namibia. If more than two Referees will be
used, insert more columns in the table below to make provision for their details. If Referees are not registered with the ECN, please write a
letter of explanation. Consideration would be given to Referees registered with other Councils. Applications without Referee Reports may not
be considered.

NAME, ADDRESS AND REGISTRATION NUMBER OF REFEREE #1 NAME, ADDRESS AND REGISTRATION NUMBER OF REFEREE #2

7. APPLICATION FEE:
NOTE: APPLICATIONS WILL ONLY BE CONSIDERED UPON RECEIPT OF THE APPLICABLE FEE

MODE OF PAYMENT: Bank Deposit or Electronic Transfer

BANKING DETAILS
Acc. Name Engineering Council of Namibia
Bank Standard Bank
Account No. 041481410
Branch Independence Avenue
Branch code 82372
Reference Your full name or ECN registration number
 Application Form - Page 3 of 4
8. CODE OF PROFESSIONAL CONDUCT (Applicable to everyone who applies for registration)

A professional engineer or an engineer-in-training, an incorporated engineer or an incorporated engineer-in-training and an

engineering technician or engineering technician-in-training shall, in practicing his/her profession, comply with the following
code of conduct:

• Have due regard to public safety and interests.

• Shall discharge his/her duties to his/her employer or client in an efficient and competent manner with complete
fidelity and honesty.

• Shall disclose to his/her employer or client, in writing, any substantial interest he/she may have in any company,
firm or person carrying on any contracting or consulting work or manufacturing business which is or may be related
to the work for which he/she is employed, as well as particulars of any royalty, gratuity, commission or other financial
benefit accruing to him/her from any article or process used in or for the purpose of the work in respect of which
he/she is employed.

• Shall order his/her conduct so as to uphold the dignity, standing and reputation of the profession.

• Shall not undertake engineering work of a nature that his/her education, training and experience have not
rendered him/her competent to perform.

• Shall certify to his/her employer or client, in writing, that he/she is competent to undertake and perform the
particular engineering work for which he/she is to be employed or commissioned.

I have read the above and undertake to comply with any provision of the Code of Conduct.

9. DECLARATION: TO BE COMPLETED BY A COMMISSIONER OF OATHS, e.g. the Police

I, _________________________________________________________________________________________ (full name)

hereby apply for registration and undertake to abide by all the provisions of the Engineering Profession Act, 1986 (Act No.
18 of 1986) and the Rules and Regulations promulgated thereunder, including the Code of Professional Conduct. I solemnly
declare that, to the best of my knowledge, all the information contained herein is true.

Signature: ______________________________________________________________________

Sworn To / Affirmed before me at __________________________________________________

on this the _________________________ day of ______________________________________(month & year)

COMMISSIONER OF OATHS /
JUSTICE OF PEACE: ………………………………….……………………………………………..……………………………… (Commissioner’s stamp)
 Application Form - Page 4 of 4

APPLICATION FORM: PROOF OF SUBMISSION

Full Name:

ECN Reg. No. (or Ref. No.):

Category applied for:

Discipline & sub-discipline:

Received by:

Signature:

ECN OFFICIAL DATE STAMP

Note that your application is well received and will be forwarded to the relevant office/committee for further processing

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